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The present invention relates generally to the transfer of multimedia information through the Internet, and more particularly to an integrated e-mail and server system for manipulating and communicating medical information.
In many fields (e.g., medicine, manufacturing, veterinary science, scientific research, etc.), it is often necessary to examine a subject and communicate the results of the examination to a remote place. Such information exchanges are especially desirable in the medical arena where it is often useful for medical practitioners to communicate medical information, such as patient test results, to other practitioners located in remote places. Telemedicine facilitates this exchange of information.
Telemedicine is an emerging field that enables medical knowledge to be shared amongst a variety of users that need not be co-located. Interest in telemedicine has exploded in the 1990""s with the development of medical devices for capturing data in digital electronic form and the establishment of high speed, high bandwidth telecommunication systems around the world. In particular, the use of the Internet in telemedicine allows a practitioner at one location to interpret medical test results and consult with another practitioner located elsewhere. Medical information transfer systems that employ the Internet allow for remote locations, such as third world countries that do not have an attending specialist, to access such medical expertise. Furthermore, emergency care may be provided where a practitioner is temporarily away, e.g., at home or on vacation. See, e.g., Thrall JH, Boland G., xe2x80x9cTelemedicine in practicexe2x80x9d, Seminars in Nuclear Medicine 28(2):145-57, April 1998.
Medical information (e.g., as may be utilized by a telemedicine system) may be derived from many different medical modalities. Such modalities may include sophisticated radiology equipment grouped as small matrix size and large matrix size instruments. Small matrix systems include equipment for magnetic resonance imaging (MRI), computed tomography (CT), ultrasonography (US), nuclear medicine (NM) and digital fluorography. Large matrix systems include equipment for computer radiography (CR) and digitized radiography (DR). Other data image acquisition equipment may be used for radiofluoroscopy, angiography, such as x-ray angiography and heart scanning. Still other equipment of great usefulness in acquiring medical information includes secondary capture devices for video, endoscopy, microscopy, and photography, such as digital cameras, scanners, electrocardiogram (ECG) machines, and the like.
The resulting medical information may take numerous forms, including text, images and video, or variations thereof, such as image overlay data, measurements, coordinates, etc. Information may also be in the form of time-dependent data including sound, such as audio dictation, and waveform data. The data may be static representations of timedependent forms, such as curves. Thus, it is advantageous for telemedicine systems that may need to transfer the data and/or information to be flexible, so as to accommodate this variety of information/data from multiple modalities.
Unfortunately, this type of flexibility is not exhibited in current systems. For example, some current medical information transfer systems have integrated medical modalities to not only generate data but also to capture data signals, to store the data and to transmit the data over the Internet. Typically, in such systems the modality has an integrated Web server, storage database and Web pages as physical parts of the modality system. A remote Web browser is allowed to request data from the modality through the Internet (e.g., via the World Wide Web) and the Web server in the modality is allowed to respond accordingly. One such system, which has restricted applicability to ultrasound machines, is described in U.S. Pat. No. 5,715,823.
One drawback of such systems is that individual Web servers are required for each medical modality unit, making it a costly endeavor to share data among a number of practitioners. Furthermore, each server is limited in use to only the attached type of medical modality.
Other systems for transferring medical files are adapted to accept data from a variety of modalities, but require an interface to convert data into transferable signals. One such system described in WO 98/24358 converts system binary file data from a modality to a compatible file of keystroke codes using an adapter. The codes are transferred to a computer, which converts the codes to American Standard Code for Information Interchange (xe2x80x9cASCIIxe2x80x9d) characters for transmission over the Internet to a host computer. This multiple file conversion process is an unnecessary burden, however, as current Internet technology does not require that information be converted into ASCII format. Presently, the Internet accepts binary Extended Binary Coded Decimal Interchange Code (xe2x80x9cEBCDICxe2x80x9d) and ASCII codes. Thus, an ASCII adapter is now an unnecessary extra device for transmitting medical data.
In addition to simply receiving the medical information, it is often important that a practitioner receive the information in a timely manner, especially where a quick diagnosis needs to be rendered for patient care. Thus, it is advantageous for telemedicine systems to rapidly transfer medical data. As noted, some current telemedicine systems rely on the Internet (i.e., as accessed through its graphically-oriented user interface, the World Wide Web) to transfer information. However, current Web-based transfer systems often suffer from long delays in downloading Web pages having complex data, such as large images. This presents a particular problem for the rapid sharing of medical information as a typical MRI study, for example, may have over 100 images, each of which may be 300 to 500 Kb in size, loading to a study of 50 to 80 Mb total.
These transfer times may be enhanced by compression of the data prior to transmission over the Internet. Traditional compression schemes (e.g., JPEG, GIF and bitmap schemes), however, tend to operate at low efficiencies. Such low compression efficiency may only provide for transfer of simple data before significant resolution losses and/or the truncation of data segments is/are experienced. With the use of high efficiency compression methodologies, such as wavelet compression techniques, transfer times can be reduced twenty fold. Unfortunately, however, the use of such high compression efficiency schemes is not prevalent among current telemedicine systems.
Another approach to solving the dilemma of lengthy transfer times is with the use of electronic mail (xe2x80x9ce-mailxe2x80x9d). E-mail provides a user with apparently instant transfer times, because information is sent as a package in advance. Using e-mail, studies may be xe2x80x9cpushedxe2x80x9d to the user so that the files are already available at the user""s computer when the user is ready to view the data. By contrast, when a user requests a Web page through a browser, each page must be separately downloaded.
Some current e-mail technologies allow for the point-to-point transfer of a variety of data from different modalities. However, these systems do not operate with a central storage system. Without a server database, the operations are limited. For example, one may not retrieve information about how multiple images relate to one another. Such relationship information is essential for studying data from certain modalities, such as radiology images, and is required for compliance with some medical industry standards, e.g., the multi-specialty DICOM Standards (as originally published by an ACR-NEMA committee sponsored by the American College of Radiology and the National Electrical Manufacturers Association as Digital Imaging and Communications in Medicine (DICOM), NEMA Publications PS 3.1-PS3.12., by The National Electrical Manufacturers Association, Rosslyn, Va., 1992, 1993, 1994, 1995).
The DICOM Standards define the form and flow of electronic messages that convey images and related information between computers. Therefore, it is desirable for medical information transfer systems to acquire and transmit complex data, such as radiology images, in a manner that complies with DICOM standards. See, e.g., Bidgood, et al., xe2x80x9cUnderstanding and Using DICOM, the Data Interchange Standard for Biomedical Imaging,xe2x80x9d J. Am. Med. Informatics Assoc., 4:3, 199-212, May-June, 1997. As indicated, however, some systems do not meet this requirement.
Other medical e-mail systems are limited to purely textual data forms. An example of a medical information transfer system of this type is described in WO 98/16893. This system allows a service request to be sent by one operator through a client system to another operator at a sponsor system. The request may be for some action to be performed by the operator at the sponsor system, such as to perform a test, or to provide authorization therefor, and the like. Although perhaps useful, these textual systems are not designed to transfer complex data, such as images and multimedia output, generated by many medical modalities.
Thus, in light of the shortcomings of the various currently available systems, there is still a need for medical transfer systems that allow for transfer of complex data from a variety of modalities over e-mail and web browser systems.
In one embodiment, a medical information transfer server is provided. The server is adapted to store multimedia medical data (e.g., parameter and/or clinical data) and includes a data interface for acquiring the medical data; a storage unit coupled to the data interface and configured to receive and store the medical data; and a user interface (e.g., a Web page) for viewing the medical data. In some cases, individual storage subunits may be used for storage of the parameter and clinical data, respectively. An assembly unit may be coupled to the user interface, the storage unit and/or the data interface. The assembly unit may be used to gather selected portions of the stored medical data (and/or new data) to form an e-mail package. In some cases, such actions may be undertaken in response to instructions from a remote user unit. Often, the server will include a processing unit, which may be coupled to the assembly unit or the data interface, configured to encode, compress and/or encrypt the medical data (e.g., prior to the data being assembled into an e-mail package, or even prior to being stored). In other configurations, separate processing units may be used for some or all of these functions. In any event, various compression schemes may be employed, such as progressive compression schemes, wavelet, motion wavelet, MPEG and/or motion JPEG schemes, and the like. In the progressive schemes, any suitable compression algorithm may be used in a looping fashion to compress the data to a desired or acceptable size. An e-mail server configured to send the user interface and the e-mail package to the remote user unit and/or another user unit may also be included. The multimedia medical data stored by the server may be text, image, overlay, 3-D volume, waveform, curve, video or sound data, or any combination thereof.
The server may further include a 3-D volumetric rendering element and/or a 3-D surface rendering element for converting 2-D images into 3-D images. Window and/or level controls may be included for establishing window and/or level default values. In some cases, an automatic e-mail control may be included to direct the e-mail server to automatically send any new medical data to the remote user unit at prescribed intervals.
Another embodiment provides a medical information transfer unit that includes a display for viewing a medical file on a user interface having at least one manipulation element for view control of the medical file, and a browser for communicating with a server having stored therein a plurality of medical files containing multimedia medical data. The browser includes a browser enhancement module configured to request a medical file from the server; decompress, decode and/or decrypt the medical file (if necessary); transfer the medical file to the display; and/or send instructions to the server to assemble and to e-mail selected medical data from the medical file (which may include clinical data, parameter data, series data, annotation data, observation data, 3-D volume data, and/or combinations thereof) to a remote user unit that is separate from the transfer unit.
The browser enhancement module may be a plug-in or an ActiveX control, where appropriate. Further, it may be configured to instruct the server to assemble selected data with new data to form a package and to e-mail the package to the remote user unit. This new data may be originally acquired by the transfer unit through an associated modality interface.
Still other embodiments may provide a computer readable medium having stored therein a plurality of sequences of instructions, which when executed by a processor, cause the processor to perform certain steps (e.g., through the use of a browser or otherwise). Among these steps may be included the steps of requesting from a server a medical file on a user interface having at least one manipulation element for view control of the medical file, the server having stored therein medical files containing multimedia medical data; decompressing, decoding and/or decrypting the medical file; transferring the medical file to a display; and/or e-mailing instructions to the server to assemble and send selected medical data from the medical file from the server to a remote user unit which is separate from the processor. The medical data may be in the form of text, image, overlay, 3-D volume, waveform, curve, video or sound data, or any combination thereof. Of course, other embodiments may provide only the instructions themselves or the instructions as carried in a data signal by a carrier wave.
According to still further embodiments, multimedia information from a variety of modalities may be assembled and communicated to remote users with improved control by the combined use of a browser enhancement module, such as a plug-in or ActiveX control, and a server. A remote user unit that includes the browser enhancement module may access and manipulate data stored in the server by sending instructions thereto. In some cases, communication is achieved, at least in-part, through an e-mail system integrated with the server, where the server assembles and sends the e-mail package. By this design, a user may transfer information stored on the user""s computer, but is not limited to e-mail transfers of such stored information. Rather, the user may access and congregate a variety of information from different sources (such as the server) or instruct the server to retrieve useful data from other remote hosts, thereby providing the user or another receiving party with a comprehensive package of information.
The benefits of information storage on the server are direct in that the type of information available to a user is flexible and may be in compliance with the DICOM Standards. In one embodiment, portions of data files are related to other portions of files stored on the server. The server may also store associated information such as specific parameters used by a modality in deriving medical data, notes and observations made by a practitioner, as well as patient histories.
Other embodiments further provide for sophisticated manipulation of data (e.g., medical information). Requested data may be received by a user unit through a user interface, such as a Web page, from a server. The user interface may provide a wide selection of view controls for optionally manipulating the manner in which data is displayed. Some or all of these controls may be included in a browser enhancement module, which may make up a portion of the user interface (with the remaining portion of the user interface being stored at the server). The server may additionally have controls such as 3-D image rendering device to allow for further viewing enhancements.
In still a further embodiment, a server and/or a browser enhancement module may be configured to receive complex data from a variety of sources. To avoid truncation during transmission of large data files, such as radiology files with numerous images, high level compression schemes, e.g. wavelet compression schemes, may be employed to reduce the size of any transferred data files. In some cases, the enhancement module may be configured to acquire and/or encode new medical data directly from a medical modality. The enhancement module may pass such new medical data to the server along with specific instructions regarding how the server is to handle the data. For example, the enhancement module may instruct the server to assemble the new data with data stored on the server and send the resulting package to another remote user. In addition, the enhancement module may be configured to direct the operation of a remote medical modality in deriving medical data.
Other features and advantages of these and other embodiments are discussed in detail below.